Pre-operative Visits

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As part of the cochlear implant process, a pre-implant evaluation is necessary to determine whether an individual is a candidate for a cochlear implant. Ideally, a cochlear implant candidate is someone who is likely to obtain more benefit from an implant than from traditional amplification (hearing aids). In addition, it is important to ensure that potential recipients and their families are well informed regarding all aspects of cochlear implantation. The evaluation process typically involves consultation with various professionals and comprehensive testing in order to fully determine the individual’s level of communicative function. The following appointments may be included in this process:

Cochlear Implant Orientation

The purpose of the orientation is to provide the individual and his or her spouse/family with information regarding the cochlear implant and the implant process. Topics discussed typically include:

How cochlear implants work

Available devices and the differences between them

Surgery and follow-up procedures

Expectations for an adult who receives an implant

Need for on-going special services following implantation

Audiological Evaluation

During the audiological evaluation, an audiologist will measure the potential recipient’s hearing levels with and without hearing aids. Testing can involve active participation (traditional hearing testing) and/or the use of special machines (otoacoustic emissions, tympanometry). Typically, the audiologist will also evaluate the individual’s understanding of speech both with and without the use of hearing aids. Based on the test results, the audiologist may recommend a trial with a different set of hearing aids (e.g., high power hearing aids or frequency compression aids). If hearing aids have never been used or have not been used for an extended period of time, a trial may be recommended.

Vestibular Evaluation

Because of the proximity of the hearing and balance organs within the inner ear, vestibular testing may be conducted to look at the health of the individual’s balance system.

Medical Evaluation

At this evaluation, the ear surgeon will discuss issues regarding the medical and surgical aspects of cochlear implantation. In addition, the physician will obtain information about the potential recipient’s medical and hearing health history, conduct an ear examination, and review available x-rays and test results in order to determine whether the individual can safely undergo the surgical procedure and whether there are any medical or structural problems that could prevent successful insertion or use of a cochlear implant.

CT Scan

This is a special type of x-ray that is used to provide the ear surgeon with information regarding the status of the cochlea and may indicate which ear would be better to implant. The physician is interested in whether the cochlea and auditory nerve canal have a normal shape and whether there is bony growth that can potentially compromise insertion of the cochlear implant electrode array (e.g., in cases where the individual has had meningitis or cochlear otosclerosis).

Expectations Discussion

The purpose for discussing expectations is to determine if an individual and his or her spouse/family have a good understanding of the benefits and limitations of a cochlear implant device. The following topics may be discussed with the individual and the spouse/family:

What factors led to an interest in cochlear implants?

Have the individual and spouse/family adjusted emotionally to the hearing loss?

Are there social situations that are of concern?

Has the individual’s hearing loss affected his/her job performance?

Has the individual’s hearing loss affected his/her marital or family relationships?

What are the family's expectations for the individual's performance with the cochlear implant?

​Are expectations realistic?

Has the individual and/or the spouse/family spoken with other implant users?

How supportive are the immediate and extended family members to the idea of an implant?

How committed will the individual be to follow-up visits?

What information is needed about assistive devices in addition to the cochlear implant?

What information is needed about support groups and individual counseling?

Other Evaluations

Additional evaluations may be recommended on a case-by-case basis. The comprehensive candidacy evaluation may require several visits to the center. For candidates who must travel long distances to reach Boys Town National Research Hospital, lodging is available at nearby hotels or at the Ronald McDonald House.

Once all team members have evaluated the potential candidate, the team will discuss the findings as a group and a representative will communicate the decision to the individual. If the individual is a candidate, pre-operative appointments and surgery will be scheduled following insurance pre-approval. If the individual is not a candidate, subsequent care or referrals will be provided, and/or a follow-up visit may be scheduled.